Neurology. 1999 Jul 13;53(1):126-31.

Baseline NIH Stroke Scale score strongly predicts outcome after

stroke: A report of the Trial of Org 10172 in Acute Stroke
Treatment (TOAST).
Adams HP Jr1, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, Woolson RF, Hansen MD.
Author information
Abstract
OBJECTIVE:
To compare the baseline National Institutes of Health Stroke Scale (NIHSS) score and the Trial of Org 10172 in
Acute Stroke Treatment (TOAST) stroke subtype as predictors of outcomes at 7 days and 3 months after ischemic
stroke.

METHODS:
Using data collected from 1,281 patients enrolled in a clinical trial, subtype of stroke was categorized using the
TOAST classification, and neurologic impairment at baseline was quantified using the NIHSS. Outcomes were
assessed at 7 days and 3 months using the Barthel Index (BI) and the Glasgow Outcome Scale (GOS). An outcome
was rated as excellent if the GOS score was 1 and the BI was 19 or 20 (scale of 0 to 20). Analyses were adjusted
for age, sex, race, and history of previous stroke.

RESULTS:
The baseline NIHSS score strongly predicted outcome, with one additional point on the NIHSS decreasing the
likelihood of excellent outcomes at 7 days by 24% and at 3 months by 17%. At 3 months, excellent outcomes were
noted in 46% of patients with NIHSS scores of 7 to 10 and in 23% of patients with scores of 11 to 15. After
multivariate adjustment, lacunar stroke had an odds ratio of 3.1 (95% CI, 1.5 to 6.4) for an excellent outcome at 3
months.

CONCLUSIONS:
The NIHSS score strongly predicts the likelihood of a patient's recovery after stroke. A score of > or =16 forecasts a
high probability of death or severe disability whereas a score of < or =6 forecasts a good recovery. Only the TOAST
subtype of lacunar stroke predicts outcomes independent of the NIHSS score.
https://www.ncbi.nlm.nih.gov/pubmed/10408548
The NIHSS supplementary motor scale: a valid tool for
multidisciplinary recovery trials.
Leira EC1, Coffey CS, Jorge RE, Morton SM, Froehler MT, Davis PH, Adams HP Jr.
Author information
Abstract
BACKGROUND:
There is a growing interest in therapies that may augment motor recovery that could be initiated in the acute stroke
unit and maintained through the rehabilitation period. Homogenization of the currently fragmented stroke
clinicometrics is necessary before such multidisciplinary trials can be conducted. The supplementary motor scale of
the NIH Stroke Scale (SMS-NIHSS) is a simple and reliable scale for assessing proximal and distal motor function in
the upper and lower extremities. We hypothesized that the currently underutilized SMS-NIHSS is a valid tool for
assessing motor recovery with prognosticative value.

METHODS:
We performed an analysis of SMS-NIHSS scores recorded in 1,281 patients enrolled in the Trial of ORG 10172 in
Acute Stroke Treatment (TOAST). We plotted the probability of a favorable outcome (FO) and very favorable
outcome (VFO) at 3 months based on the baseline SMS-NIHSS scores. In order to better study the relationship
between SMS-NIHSS and 3-month functional outcome, we performed multivariate logistic regression analyses using
both FO and VFO as outcome measures. Analyses were adjusted for potential confounders such as age, sex, side
of the lesion, time from symptom onset to emergency room arrival, temperature, systolic blood pressure, blood
glucose level and treatment group assignment (ORG 10172 vs. placebo). We also calculated the Spearman
correlation coefficient between the SMS-NIHSS, Barthel Index (BI) and Glasgow Outcome Score (GOS) obtained at
the 3-month visit.

RESULTS:
The mean SMS-NIHSS scores were 8.18 at baseline and 4.68 at 3 months. The SMS-NIHSS scores showed a
gradual improvement during the first 3 months after stroke. There was a linear relationship between the baseline
SMS-NIHSS scores and the probability of an FO or VFO at 3 months. The SMS-NIHSS baseline score was an
independent predictor of FO (OR = 0.86; 95% CI 0.84-0.87; p < 0.0001) and VFO (OR = 0.85; 95% CI 0.84-0.87; p <
0.0001) at 3 months after adjusting for confounders. The degree of improvement in the SMS-NIHSS scores from
baseline to 3 months was also independently associated with FO and VFO (p < 0.0001). At 3 months, SMS-NIHSS
scores showed a strong correlation with the BI (r = -0.70; p < 0.0001) and GOS (r = 0.73; p < 0.0001).

CONCLUSIONS:
The SMS-NIHSS is a valid scale for assessing motor recovery with prognosticative value, and may be sensitive to
changes during recovery. Given that the SMS-NIHSS is an extension of the widely accepted NIHSS, it could be
easily implemented in trials conducted in a variety of clinical research settings, including acute stroke hospitals and
rehabilitation units.
https://www.ncbi.nlm.nih.gov/pubmed/23921195